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Health Rate Target Medical Loss Ratio (MLR) Exemption Requests

In compliance with the “Reasonable Health Insurance Ratemaking Reform Act of 2010” (DC Law 18-360), the Department of Insurance, Securities and Banking (DISB) is providing consumers/public with a list of rate filings that have requested an exemption to the target medical loss ratio set forth in subsection (e) of Section 102 of this Law. The purpose of the list is to provide a 30-day period of public notice and comment as set forth in subsection (f) of Section 102 of this Law.

(e) Except as provided for in subsection (f) of this section, for any rate filing, the carrier shall demonstrate that the product for which the rate is filed has a target medical loss ratio of 70% or greater for individual and small group policies and 75% or greater for large group policies.

(f) The Commissioner of the Department of Insurance, Securities, and Banking (“Commissioner”), in his or her discretion, may approve an exemption to the target medical loss ratio set forth in subsection (e) of this section, upon receipt of justification supporting the requested exemption and after a 30-day period of public notice. Justification for a medical loss ratio of less than 70% for individual and small group policies or less than 75% for large group policies shall be based upon the following factors: